Healthcare: What Might Have Been

Long before the sexting scandal that ended his career, Rep. Anthony Weiner advised the president on how to pass healthcare reform. Robert Draper reports in his new book, “Do Not Ask What Good We Do,” that in September of 2009 Mr. Weiner told the president, “I think you’re looking at this entirely the wrong way. You need to simplify it. Just say that what we’re doing is gradually expanding Medicare.”

That was code for a single-payer system, which the president insisted could never pass. But Mr. Weiner was undeterred: “You only have votes for something when you go out and fight for them.”
It’s impossible to say what might have happened if Mr. Obama had listened to Mr. Weiner, but with hindsight it’s obvious that his strategy had certain advantages. By framing the Affordable Care Act as an expansion of an already popular program—instead of as a bold new experiment—the Democrats could have better defended themselves against right-wing attacks. The ludicrous “keep government out of my Medicare” meme might never have taken off. Maybe we’d have ended up with the single-payer system liberals wanted instead of the Heritage Foundation-inspired individual mandate, which might not even survive Supreme Court review.

Mr. Weiner wasn’t the only congressman to pitch an alternative approach. According to Mr. Draper, John Tanner, a Blue Dog Democrat, told House Speaker Nancy Pelosi that she should “break the bill down:”

Have a bill that covers pre-existing conditions. Pass that—or make the Republicans vote against it—and then move onto another part. But you do this omnibus approach, they won’t know what the hell’s in it. And they’ll keep yelling at it.

Mr. Tanner was right about the yelling, and maybe about everything else. According to the Kaiser Family Foundation, the “component parts” of the ACA have been “consistently popular” over the past two years with one “glaring exception:” Only 32 percent favor the individual mandate. It stands to reason that it’s discomfort with the mandate, and that alone, that drives a plurality of Americans to say Congress should repeal the ACA (about 38 percent, depending on the poll, with about 20 percent wanting to leave it as is, and 33 percent favoring expansion).

Under Mr. Tanner’s scheme, the Democrats could have campaigned on the “component parts,” described the mandate as a payment mechanism, and defied the opposition to come up with a viable alternative to it.